Suicidal Behaviors Linked to Steroid Treatments

The research study that I am highlighting this month is especially for mental health professionals who follow my newsletters.  It may explain in part why your patients may do very well and then suddenly they are more depressed or suicidal.  The summary, which follows, discusses how glucocorticoid (steroid) therapy can increase depression and suicidal ideation in your clients.

Most commonly, I have seen Prednisone prescribed for bronchitis or asthma.  Sometimes steroids are also used for acute flare-ups of autoimmune diseases such as MS.  Although the research did not specifically look at local injections of steroids for joint pain, I have seen a few patients in my office struggling with depression and the deepening of the depression within the three-month window of steroid injection(s) for knee pain.

Let me state again: I am not against the use of medications.  I simply want people to know that they may experience depression or suicidal behaviors as a side effect of this medication.  If they wait it out, those side effects will go away.

In a United Kingdom study over a period of 18 years, researchers assessed 372,000 adult patients who received prescriptions for oral glucocorticoid compared with those patients who did not receive such prescriptions.  This is the largest study to date examining the effects of glucocorticoid treatment on adverse neuropsychiatric outcomes.

Simply put: Glucocorticoids increase the risk of suicidal behavior and neuropsychiatric disorders.

Authors Fardet, Petersen, and Nazareth reported “finding a high incidence of neuropsychiatric adverse events in the first 3 months of treatment with glucocorticoids.  Over all, the incidence was 15.7 per 100 person-years at risk.  For patients on their first course of glucocorticoids, it was 22.2 per 100 person-years at risk.  Older men were at higher risk of delirium, confusion, disorientation, and mania, while younger patients were at higher risk of suicide or suicide attempt.  Patients with previous histories of neuropsychiatric disorders and those treated with higher dosages of glucocorticoids were at greater risk for neuropsychiatric outcomes.”

These research findings should give us all pause.  Physicians must exercise caution in administering these drugs.  All of us have monitoring responsibilities.  Information and education for patients and their families are very important in order to eliminate, as much as is possible, adverse reactions and misinterpretations of side effects.

Preventing CEO Burnout

John, the CEO of a mid-size family company, has been putting in 90-hour workweeks for 11 months.  Between the tight economy, an aggressive new competitor, and several family dramas, his taking a vacation now has been out of the question.  It is hard for John to get to sleep; it is even harder for him to stay asleep, and his brain turns off only after several cocktails before going to bed.  John knows that he can’t continue this pattern, but he doesn’t know how to stop, or frankly, what else to do.

One night recently, he woke up gasping for air.  John and his wife thought that he might be having a heart attack and frantically called 911.  As they waited for the ambulance’s arrival, several heavy thoughts registered in a back corner of John’s mind.  He was simultaneously afraid and relieved:  Afraid . . . This is it!  I’m going to die.  And yes, relieved:  Why, if I were to survive the heart attack, I might actually get a break!

At the ER, the medical team conducted blood tests and monitored his heart.  After several hours, the team informed John that he had experienced a panic attack.  He was given two prescriptions and encouraged to check in with his primary care physician as soon as possible. The first prescription was for four days worth of Clonazepam, a benzodiazepine that immediately quiets the brain, but is very addictive.  Also, the ER doctor prescribed Celexa, an antidepressant that aids in reducing anxiety.

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The experience stunned John.  “I’m not the sort of guy who has panic attacks!”  Then, dozens of other questions came:  What does this mean? . . .  Am I not cut out for this level of leadership? . . .  Am I failing and don’t know it? . . . How can I take care of the company and my family, if I am not a strong leader? . . .

After taking a couple of days off, “due to a family emergency,” John returned to work and to the stress that comes with being a man who has many people depending on him and great responsibilities.  Soon, getting access to another Clonazepam tablet became a daily matter for him - a disturbing and frightening concern because he has seen other family members struggle with addictions to prescription drugs.  He called his family physician whose only suggestion was to take time off.

On Tuesday, May 7, 2013. The Wall Street Journal published Leslie Kwoh’s article “When the CEO Burns Out.” She listed fatigue, resentment, and loneliness as causes for burnout.  She gave examples of well-known companies that have lost valuable leadership, when men and women took vacations and/or left to recover physically and mentally.   As remedies. she suggests time off and medications, as needed.

Wait a minute.  We can do better than that!  CEO and C-suite executives do not burn out.  Their brains and bodies do! These same brains and bodies begin to break down when they are exposed to chronic stress.  A common symptom of CEO breakdown caused by chronic stress is loss of a person’s ability to focus. 

In prudent organizations today, leaders understand that executive brains and their physical well-being are the most important assets of any venture.  Therefore, owners and boards of directors anticipate their organization’s needs; after all, they are used to essential scheduled maintenance on machines.  It’s required for all human assets too!

The idea is a sound one.  Therefore, it doesn’t take long for someone to ask: What should be included in an organization’s prevention plan for executive burnout?  At a minimum plans should include:

 1.    Instilling in your corporate culture the behaviors that increase the body’s ability to cope with stress.  These tenants are eight hours of sleep, 30 minutes of exercise daily, and at least three meals with protein and vegetables per day. 

 2.   Insisting on time away:  Our brains function better when we take time away from complexity and sameness.  Rest, relaxation, and discontinuous time and activities produce fresh perspectives - essential in thinking strategically.

 3.  Scheduling annual physical examinations with primary care physicians for C-suite executives.  Metrics of high blood pressure, high cholesterol, and weight gain are symptoms of a body not handling stress well.

Rather than being surprised and in crisis when an executive must step out or step down, which is extremely costly, why not create a preventive maintenance plan for key executives in your organization?